Comparison of procedural efficacy and biophysical parameters between two competing cryoballoon technologies for pulmonary vein isolation: Insights from an initial multicenter experience

• Published in: Journal of Cardiovascular Electrophysiology
• Main Authors: Yap, Sing, Anic, A, Breskovic, T, de Haas, A, Bhagwandien, Rohit, Jurisic, Z, Szili Torok, Tamas, Luik, A
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2021
• Subjects: Arctic
• Online Access: https://pure.eur.nl/en/publications/b60985f5-4d19-4568-a6a6-2b4c61062ea1; https://doi.org/10.1111/jce.14915; https://pure.eur.nl/ws/files/48449327/Repub_134391_O-A.pdf; http://www.scopus.com/inward/record.url?scp=85100107285&partnerID=8YFLogxK; https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jce.14915

Introduction: Recently a novel cryoballoon system (POLARx, Boston Scientific) became available for the treatment of atrial fibrillation. This cryoballoon is comparable with Arctic Front Advance Pro (AFA-Pro, Medtronic), however, it maintains a constant balloon pressure. We compared the procedural efficacy and biophysical characteristics of both systems. Methods: One hundred and ten consecutive patients who underwent first-time cryoballoon ablation (POLARx: n = 57; AFA-Pro: n = 53) were included in this prospective cohort study. Results: Acute isolation was achieved in 99.8% of all pulmonary veins (POLARx: 99.5% vs. AFA-Pro: 100%, p = 1.00). Total procedure time (81 vs. 67 min, p <.001) and balloon in body time (51 vs. 35 min, p <.001) were longer with POLARx. After a learning curve, these times were similar. Cryoablation with POLARx was associated with shorter time to balloon temperature −30°C (27 vs. 31 s, p <.001) and −40°C (32 vs. 54 s, p <.001), lower balloon nadir temperature (−55°C vs. −47°C, p <.001), and longer thawing time till 0°C (16 vs. 9 s, p <.001). There were no differences in time-to-isolation (TTI; POLARx: 45 s vs. AFA-Pro 43 s, p =.441), however, POLARx was associated with a lower balloon temperature at TTI (−46°C vs. −37°C, p <.001). Factors associated with acute isolation differed between groups. The incidence of phrenic nerve palsy was comparable (POLARx: 3.5% vs. AFA-Pro: 3.7%). Conclusion: The novel cryoballoon is comparable to AFA-Pro and requires only a short learning curve to get used to the slightly different handling. It was associated with faster cooling rates and lower balloon temperatures but TTI was similar to AFA-Pro.